应用替比夫定和替诺福韦治疗阻断血清HBV DNA高载量孕妇母婴传播的效果分析  

Efficacy of telbivudine and tenofovir in blocking mother-to-infant transmission of hepatitis B virus in pregnant women with high serum HBV DNA loads

作　　者：周娟[1] 刘月合[1] 王春佟 Zhou Juan;Liu Yuehe;Wang Chuntong(Department of Gynecology,3201^st Hospital Affiliated to Xi'an Jiaotong University,Hanzhong 723000,Shaanxi Province,China)

机构地区：[1]西安交通大学附属汉中3201医院妇科,陕西省汉中市723000

出　　处：《实用肝脏病杂志》2020年第6期805-808,共4页Journal of Practical Hepatology

基　　金：陕西省科技厅科研基金资助项目(编号:2018489)。

摘　　要：目的比较应用替比夫定(LdT)和替诺福韦(TDF)治疗血清乙型肝炎病毒(HBV)脱氧核糖核酸(DNA)高载量孕妇,阻断病毒母婴传播的疗效。方法2017年7月~2019年6月我科诊治的血清HBV DNA高载量(>1×10^6 IU/mL)孕妇85例,随机分为两组,分别在孕28周时接受LdT治疗(n=43)或TDF治疗(n=42)至分娩结束。新生儿出生时规范接受乙肝疫苗和人乙型肝炎病毒免疫球蛋白接种,新生儿或婴儿血清HBV DNA>5×10^2 copies/mL或HBsAg阳性,视为HBV感染。结果在分娩结束时,LdT治疗组妇女血清HBV DNA和HBeAg水平分别为(2.9±0.6)lg IU/mL和(939.5±286.6)S/CO,与TDF治疗组的[(3.1±0.7)lg IU/mL和(940.7±285.6)S/CO,P>0.05]比,无显著差异,两组血清HBsAg、ALT和AST水平均无显著变化;LdT治疗组妇女所生新生儿出生胎龄为(39.4±1.2)w,身长为(50.9±2.8)cm,头围为(33.8±1.3)cm,体质量为(3087.9±471.5)g,Apgar评分为(9.5±0.4)分,与TDF治疗组比,差异无统计学意义[分别为(39.6±1.1)w、(51.2±3.1)cm、(33.9±1.5)cm、(3112.9±464.9)g和(9.6±0.6)分,P>0.05];随访婴儿至12个月,两组分别有1例(2.3%对2.4%)幼儿发生HBV感染。结论应用LdT或TDF治疗孕晚期血清高HBV DNA载量的乙型肝炎病毒携带孕妇均可阻断HBV母婴传播,效果肯定,值得临床开展大规模研究。Objective The aim of this study was to compare the efficacy of telbivudine(LdT)and tenofovir disoproxil fumarate(TDF)in blocking hepatitis B viral transmission from mother to infant in pregnant women with high serum hepatitis B virus(HBV)deoxyribonucleic acid(DNA)loads.Methods 85 pregnant female HBV carriers with serum HBV DNA>1×10^6 IU/mL were recruited in this study,and randomly divided into two groups,receiving LdT(n=43)or TDF(n=42)at gestational 28 weeks.The antiviral regimen lasted to the delivery.Serum HBV DNA and/or HBsAg positive were defined as HBV infection.Results At the delivery,serum HBV DNA load and HBeAg level in LdT-treated women were(2.9±0.6)lg IU/mL and(939.5±286.6)S/CO,both not significantly different compared to[(3.1±0.7)lg IU/mL and(940.7±285.6)S/CO,respectively,P>0.05]in TDF-treated women,and serum HBsAg,ALT and AST levels in the two groups were not much different(P>0.05);in LdT group,the infant’s gestational age was(39.4±1.2)w,the height was(50.9±2.8)cm,the head circumference was(33.8±1.3)cm,the body mass was(3087.9±471.5)g and the Apgar score at one minute was(9.5±0.4),all not significantly different compared to[(39.6±1.1)w,(51.2±3.1)cm,(33.9±1.5)cm,(3112.9±464.9)g and(9.6±0.6),respectively,P>0.05]in TDF group;the infant’s HBV infection was 2.3%vs.2.4%in the two groups(P>0.05).Conclusion Both LdT and TDF could be orally given to pregnant women with high serum HBV DNA loads at gestation of greater than 28 weeks to block mother-to-child HBV transmission,and worth further clinical investigation.

关 键 词：乙型肝炎病毒携带者 妊娠 替比夫定 替诺福韦 母婴传播 

分 类 号：R714.251[医药卫生—妇产科学]